Systematic review of colorectal cancer screening guidelines for average-risk adults: Summarizing the current global recommendations

Table 2 Summarized recommendations for colorectal cancer screening in average-risk individuals, published in Europe between 2007 and 2017

Continent	Country/Association	Year	Age	Screening tests recommended	Recommendation	Note
Europe	Scotland: TIS	2011 (revised in 2016)	Age not mentioned	FIT (quantitative) (interval not mentioned)	Grade A recommendation	Performance of FS unsure in the Scottish population. Colonoscopy and CT colonography are not recommended
	Germany: GGPO	2014	≥ 50	Preferred test: Colonoscopy (10 yr) If refused by individual: FS (5 yr) + annual FOBT OR Annual FOBT	Colonoscopy: Grade B recommendation; 3b level of evidence. FS: Grade B recommendation; 2b level of evidence. Adding FOBT to FS: Grade B recommendation; 3b level of evidence. FOBT as a screening test: Good clinical practice	General use of FIT is not recommended, but FIT can be used instead of gFOBT if it has a proven high specificity (> 90%) and sensitivity. Genetic stool tests, CT colonography, MR-colonography and capsule endoscopy are not recommended.
	Spain: SEOM	2014	50-74	FIT every 2 yr OR, depending on available resources, annual or biennial gFOBT OR FS (5 yr) OR colonoscopy (every 10 yr)	Grade B (moderate) quality of evidence, except for FOBT every 2 yr (grade A quality of evidence)	Combination of gFOBT and FS, and CT colonography are not recommended
	European Guidelines	2013	50-74	Recommended test: gFOBT/FIT (1-2 yr)	Recommendation based on good evidence for gFOBT, reasonable evidence for FIT and FS, and limited evidence for colonoscopy	Evidence supports FIT superiority compared to gFOBT
				Other options include colonoscopy (10-20 yr) OR FS (10-20 yr)

CRC: Colorectal cancer; FS: Flexible sigmoidoscopy; FOBT: Fecal occult blood test; gFOBT: Guaiac-based fecal occult blood test; FIT: Fecal immunochemical test.